Sunday, May 13, 2012

Sad News ! setting treatment goals is easier than achieving treatment goals.

Heart Disease is the # 1 killer of people with Diabetes. Numerous studies have have shown the benefit of controlling individual risk factors in preventing and slowing heart disease. An article published in Diabetes Care 2011;34:1337-1343 discussed the evidence ,  showing that  the 10 year coronary risk has improved significantly .  I will  review the risk factors and my failure to reach my goals. I am also offering you a little challenge from someone who is better at giving advice than taking advice.

Individualizing Targets 
 If you have my  book , iPhone or iPad app, Diabetes Office visit, please go to the goal setting section and review your goals as we review these risk factors.Another point I would like to make is ,as  I pointed out in my book ,  treatment goals are very individual , one size does not fit all . My recommendation is that you and your physician discuss each goal and make adjustments as needed . With the iPhone and iPad app it is very easy to adjust the goals to your specific life circumstances.

New Position statement by the American Diabetes Association
I was very happy to see Ann Peters, MD comments in Medscape 4/20/12 , on the new position statement on managing of hyperglycemia to be published by the American Diabetes Association and the European Association for the study of Diabetes essentially focused on patient-centered guidelines.. I think it is good to now have a name for what doctors have been doing in their offices for years. A good example is A1c hemoglobin. I will quote Ann Peters remarks to emphasize the point. "I think each of us can think of patients in our practices who can achieve an A1c  that is even below 6.5, as close to normal as possible. Then their are others who are older, have comorbidities, and are not able to safely get their A1c down that low, so we raise the targets. I think the notion of adjusting targets, individualizing targets, is the key to this position statement ".

 Target goals
      *  A1c < 7
      *  Blood Pressure                        <130/80
      *  LDL cholesterol                      < 100 mg/dl for low risk individuals    Apo B < 90
                                                          <  70  mg/dl for higher risk individuals ApoB  < 80
      *  Total cholesterol                      <200 mg/dl  ( 96mm/l)
      *  Triglycerides                           <150  mg/dl (1.7mm/l)
      *   HDL cholesterol                     > 40 mg/dl for men (1 mm/l)
                                                           > 50 mg/dl for females (1.3mm/l )
      * Albumin / Creatinine ratio        < 30 mg/24 hours  (3.4 mm/l )
      * abdominal girth                        <  38  inches for males (96 cm )
                                                          < 35  inches for females ( 88.9 cm )

Home work -  I am sad to report that ! Achieving goals involves more than just setting goals
     For those of you with Diabetes Office visit App or with the book go to the risk management section and make to make sure your lab reports are up to date and that you have achieved your targets. I just looked at my target goals and reviewed my success in the risk management section.  I am proud to announce that have reached all of the goals except the most difficult ones , my weight and waist size.My goal was to have my weight down to 187 pounds and my waist to < 38 by July 2012.  It is May 13 and my weight is 191 pounds and my waist  is 40 inches. Yipes I will have to lose 4 pounds and shrink my waist by 2 inches by July to meet my goals. It is amazing how fast this year has passed. I think achieving goals requires more than just setting goals. One of my other goals was to be doing 100 pushups /day using the 100 pushups App. I did very well for about 2 months and actually got up to 80 . Then I  missed a day or 2 or 3 or month and did not continue . This same thing happens with food intake and other forms of exercise.
Does any one want to join me in losing 4 pounds in the next 2 months?
Make a comment and a commitment and lets discuss our plans.
  use the comment section or email me at:

Have fun , Be smart , Set treatment goals and then find the hidden inner strength to achieve those goals.

 David Calder, MD

ps. Mark Clifford recommended trying The Live Strong diet tracking app. I am trying the free version and it looks good after my first day look. I must admit that it also requires some commitment. I neglected to put my lunch and Dinner in yesterday.

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Your comments and questions are appreciated. David Calder,MD